title: Group versus single handed primary care: a performance evaluation of the care delivered to chronic patients by Italian GPs.
abstract: OBJECTIVE
  In family medicine contrasting evidence exists on the effectiveness of team practice compared with solo practice on chronic disease management. In Italy, several experiences of team practice have been introduced since the late 1990s but few studies detail their impact on the quality of care. The aim of this paper is to evaluate the impact of team practice in family medicine in six Italian regions using chronic disease management process indicators as a measure of outcome.
  
  
  METHODS
  Cross-sectional studies were performed to assess impact on quality of care for diabetes, congestive heart failure and ischaemic heart disease. The impact of team vs. solo practice was approximated through performance comparison of general practitioners (GPs) adhering to a team with respect to GPs working in a solo practice. Among the 2082 practitioners working in the 6 regions those assisting 300+ patients were selected. Quality of care towards 164,267 patients having at least one of three chronic conditions was estimated for the year 2008 using administrative databases. Quality indicators (% of patients receiving appropriate care) were selected (4 for diabetes, 4 for congestive heart failure, 3 for ischaemic heart disease) and a total score was computed for each patient. For each disease the response variable associated to each physician was the average score of the patients on his/her list. A multilevel model was estimated assessing the impact of team vs. solo practice.
  
  
  RESULTS
  No impact was found for diabetes and heart failure. For ischaemic heart disease a slightly significant impact was observed (0.040; 95% CI: 0.015, 0.065).
  
  
  CONCLUSIONS
  No significant difference was found between team practice and solo practice on chronic disease management in six Italian regions.
authors.affiliation: Agenas - Agenzia Nazionale per i Servizi Sanitari Regionali, Via Puglie, 23, 00187 Roma, Italy. Electronic address: visca@agenas.it.
authors.forename: Modesta
authors.initials: M
authors.lastname: Visca
authors.forename: Andrea
authors.initials: A
authors.lastname: Donatini
authors.forename: Rosa
authors.initials: R
authors.lastname: Gini
authors.forename: Bruno
authors.initials: B
authors.lastname: Federico
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Damiani
authors.forename: Paolo
authors.initials: P
authors.lastname: Francesconi
authors.forename: Leonardo
authors.initials: L
authors.lastname: Grilli
authors.forename: Carla
authors.initials: C
authors.lastname: Rampichini
authors.forename: Gabriele
authors.initials: G
authors.lastname: Lapini
authors.forename: Carlo
authors.initials: C
authors.lastname: Zocchetti
authors.forename: Francesco
authors.initials: F
authors.lastname: Di Stanislao
authors.forename: Antonio
authors.initials: A
authors.lastname: Brambilla
authors.forename: Fulvio
authors.initials: F
authors.lastname: Moirano
authors.forename: Donata
authors.initials: D
authors.lastname: Bellentani
mesh_terms: D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006123:Group Practice / Q000592:standards*; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D011320:Primary Health Care / Q000592:standards*; D011331:Private Practice / Q000592:standards*; D011787:Quality of Health Care
keywords: Chronic disease; Evaluation; GPs practice; Process indicators